Sometimes in trying to get a practice started, 
it’s easy to overlook logical steps. Last month, I received a couple of emails from a reader that I’ll call “Stephanie.” Stephanie wrote . . .
I am on 13 insurance panels, have been doing everything possible (since April) that I know how to do and have not received one call.
I would do anything to accept private pay.
My unemployment benefits ran out in September and I applied for food stamps yesterday.
I am revising my website for the third time to focus on clients who are ________ and are non compliant in hopes I can market to and get referrals from physicians.
I never thought it would come to this. I am trying not to panic”
And, in a follow up email she wrote . . .
I have not built a referral base. I’ve been working in agencies with clients who are ________. Not my ideal clients. I only recently returned to the city and know few in private practice. I have been working on marketing 8-12 hrs a day, but not getting ‘out there’. I don’t know how.
I am changiing my niche to aging and dementia using CBT. Not many therapists do this.
I am 55 and have also tried for 2 years to get a job to sustain me.
I sound pathetic but am not. I am determined to make this private practice work. All I need are five clients to start so I can survive.
I hate the idea of insurance panels but I have no choice. I am desperate.
You can use my note but not my name.
I value any advice you can give and thank you for your kind words.”
I thought this might be a good opportunity for you to help Stephanie out.
What is she doing well?
What might be her strengths?
What seems logical to you that she might be missing?
Wiithout any magical solutions, without making anything up, and without adding any information that you have not been given – can you comment on what Stephanie might need to hear and focus on to get her practice on track?
And, what is the logical step that you are missing in your own marketing efforts?
Hi Tamara,
I’m interested in learning more about what her marketing consists of, given the amount of hours she dedicates to it, the fact that she is not “getting out there” and why she is not building a referral source. I’ve learned that these are essential ingredients when building up a successful practice.
Yes! Christine! You make a good point! “Doing everything possible” might mean staying really really busy doing everything except “getting out there.” And, what I know is that getting out there is half the battle.
I am wondering if she can be involved in community events and serve on some committees to get her name and face out in her community. I find that networking has helped me with referrals.
Mary! Theses are excellent suggestions that can move a practice forward. These are excellent suggestions for “getting out there” and getting known – personally and professionally. Thanks for the reminders!
Stephanie, clearly you have dedication and focus, which is AWESOME! Also having a niche will make it SO MUCH easier for you to market yourself.
I think you DO need to get out there in person and I would do that by looking around and seeing what your community has to offer. Are there chambers of commerce with free meet-ups that you can attend? Are there are any other groups whose events you could check out? Like a local chapter of NAWBO (National Association of Women Business Owners)? I wouldn’t join any of these yet because joining can get expensive but I’d start visiting them to get a sense of where your clients or referral sources might be. Eventually it might be cost-effective to join but I would definitely get myself out there in person and start figuring out the lay of the land.
I would also send letters of intro to local doctors who treat the clients you want to see and if there are local senior centers, I would see about bulletin boards they let the public post to or if they give referrals. Are there support groups for caretakers? Who sponsors them? Can you get on their list of referrals?
Are you comfortable with public speaking? Does your local library or community center host informaiton nights or workshops? If you are and they do, I would come up with some canned lectures that you feel comfortable giving about your area of expertise. Then once I have those organized I would send notices out to local community groups offering your services as a speaker.
This IS hard work, I know and it does take time. But you will see your investment pay off and it gets easier as you go because the networking you do is like ripples and as they move further out, you’ll see your way made easier. Hang in there.
Thanks, Dawn, for taking time to share some really great ideas with us. I, too, heard Stephanie’s dedication and focus. It is important, though, to maintain that focus on that niche. Changing every year to a different niche makes it difficult to build a reputation around a specific niche. So, Stephanie, settle on one and become the expert in town on that particular area. Don’t get scared and think that you need to keep shopping for the niche.
I have started my practice from scratch twice in my career (now in my 35th year of independent practice). Both times the key to getting started was face-to-face visits with female family physicians/primary care docs. I wrote up a description of my practice, briefly mentioning my training and experience, and brought it along with me to the visit. I arranged these visits by cold-calling doctors’ offices and asking the receptionist if I could come and see the doctor just for a few minutes at a convenient time. Some said no right away, some said yes and then were unavailable when I showed up (!), and some said yes and then actually gave me some time. You have to make a good, focused presentation but also be relaxed and friendly. All it took was one or two of them to send a patient my way, and for the patient to get something out of the sessions, for my practice to get underway. I say “female”, although I called both male and female doctors, because it was the females who ended up sending me the patients at first. They are just more aware of the value of counseling and more able to communicate that to their patients when making the referral.
Susan, thanks so much for sharing your encouragement! You’ve laid out a really clear path to marketing to physicians in the area. And, Stephanie, if cold-calling physicians’ offices gives you the heebie-jeebies, consider warm-calling. The difference is getting others to introduce you to physicians and then following up with them on your own.
If the niche is aging and dementia, then make sure you accept the services they come with, namely Medicare and Medicaid. Is the office elderly accessible? If dementia is the target, then market to their caregivers, find support groups and visit every elderly care home in a 15 mile radius. Send cookies and brochures to the Visiting Nurse Assoc in the area and to home health aides. If clients aren’t aware of how CBT can help their loved ones, then tell them how in clear and non-clinical terms. Simple phrases, easily accessible ideas. “CBT” will mean very little to a stressed-out adult child of a parent who is falling into dementia, they just want help. How – exactly – are you the best person to help them? Asking for referrals rarely works. Show the potential referral sources exactly how you can help them solve a specific problem. If you have changed your niche and focus, why? If you don’t have cred in serving this niche then what is the reasoning to abandon the old one?
Katherine! Thank you so much for focusing in on Stephanie’s interests in aging and dementia! You’ve made some excellent points that can certainly serve Stephanie and many others well. What i know about this particular niche is that – except for Christmas – these caregivers are largely overlooked, taken for granted, and completely ignored. A little Tender Loving Care directed toward supporting the needs of these caregivers is often on over-looked opportunity to grow a mental health professional’s private practice.
And, you questions about the decision to change a niche along with questioning Stephanie’s authority in this area are fair and useful questions for all of us to ask ourselves. If we have not built up our credibility beyond obtaining a Master’s degree or Doctorate, then it is difficulty to position ourselves as being the one to have the privilege of working with caregivers’ loved ones. I’m not really questioning Stephanie’s experience and expertise so much as I am suggestion that all of us need to consider what it is like to choose a mental health professional to work with. The risks can seem really high to those seeking our services.
Poor Stephanie! It sounds like she is incredibly dedicated and really trying to be innovative by looking at her niche and reaching out to you! Without being able to see her site, I’d say that having a warm and helpful site is really key. The fact that she has revised it three times means that she knows it needs to be good, and has the determination to address it. I wonder if she is improving the actual content, or just giving it a costume change with each subsequent niche that she promotes? Others could speak to building a referral base better than I can, but so far I have learned that you gotta get out there and make friends- does her area have the equivalent of a Private Practice Network? Stephanie – if you want even more folks to give you some feedback on your site or show you some cool online groups, I’d love to help too! You can contact me through my site. Good luck!
Ooooh, Kat! You just took this conversation in a whole new – and equally important – direction! Thanks so much! You are right! It might be that she either has no website or doesn’t have one that represents her well. I, too, am always tweaking my websites. However, that’s really different than completely changing it up. Those “costume changes” that you refer to can be frustrating to visitors and costly to the owners of a website. I tell me consulting clients that content rules! If you aren’t prepared to continue to create and curate great content for your website, then there is no reason to have a website.
And, I also appreciate your suggestion to “get out there and make friends” – both in person and online. The Private Practice Network is a great example of an online discussion group, forum, and directory (focused only on mental health professionals in Colorado) all rolled into one.
Kat, I also appreciate you extending your offer to show Stephanie and others around online, too. That’s exactly why I love our online community here! As we continue to grow here at Private Practice from the Inside Out, our resource and support continue to grow.
Stephanie, I hope you and others are finding this online community to be exactly what you are looking for and I hope you will drop back in to let us know what is / isn’t working for you!
Yes, I would be nowhere if I hadn’t been shown around! You were the one that told me about the PPN, and connecting with folks and seeing what groups they belong to on LinkedIn and such really helped me feel like I have an actual community. This provides answers, support, ideas, and the feeling that you are NOT alone or CRAZY (for wanting to be a private therapist!) I love the warmth and community here on this site and I hope that everyone can find and cultivate those things as well!
Thanks, Kat! It does feel like a warm community here and that was the goal when I started it back in 2009. I knew from personal experience that there’s no need and no benefit to looking at our colleagues as being our threats. They aren’t. There’s plenty of clients to go around – think about your friends and mine, your family members and mine, your neighbors up and down the street and mine, and your colleagues and mine. There is no shortage of people needing mental health services.
Instead, there is a shortage of mental health professionals who know how to talk about and market their own services. And, I’m here – we’re all here – to change that! I’m happy to help connect the dots and I see, Kat, that you are too! There’s no reason each of us can’t build a strong and vibrant private practice!
Strengths: Stephanie seems to be spending a lot of time on marketing and also has a niche that she feels will fill a gap, which I see as a strength. What I think might be helpful to Stephanie since she is in a city where she knows few private practitioners is to find some type of local networking group, and maybe even do some workshops about her niche geared towards professionals that might be referral sources (doctors, those who care for dementia patients, etc…). Also I would ask Stephanie to explore what other types of clients she might enjoy that are closely related to her niche, maybe broaden a little bit to get started. Hope this is helpful. I totally feel her pain, it’s a tough market right now.
Jill, it’s lovely to hear from you today! I so appreciate you noting some of the positives that Stephanie can build on. And, I think you have noted a possible solution for her isolation. Finding support and / or creating support for therapists is really critical for those of us in private practice. When I first moved to Colorado from Texas I could not find any networking groups for mental health professionals. That’s why I ended up creating a consultation group. And, now, although there are many opportunities for mental health professionals on the Front Range of Colorado to network, my consultation group is my Source – for strength and correction, for new ideas and inspiration. Whatever it is that you need to do, Stephanie, to find / create that support, do it now.
And, Jill, your suggestion to provide training to potential referral sources rather than directly to clients is BRILLIANT! That is absolutely one way to gain a footing in the community as the expert!
Staphanie,
I was told it takes 3-5 years to get a practice off the ground. I was determined to make it happen sooner, so one of the first things I did was hire a coach. A coach can help a person stay focused in the thick of things. It is easy to get lost, distracted, desperate and needy. Offering services from a “love of the work” place is different than “I am desperate for clients” place. If a coach is not possible, author Lynn Grodzki’s book, Twelve Months to Your IDEAL Practice Practice, is a useful resource. Another book I keep on my desk as a resource is David P. Diana’s book, Marketing for the Mental Health Professional, and it is an easy read.
Also, attracting my ideal clients that I am passionate about working with is important. Working with a population which is a good fit is energizing. My best work comes from within the passion I hold in my heart for my niche population. My branding, marketing and networking strategies are all driven from the passion I have in working within my niche. Stephanie, you are invited to take a look at my blog/website, http://www.CreatingYourBeyond.com. Then if you want to give me a call or email me I can answer any questions you may have ~ privately off-line.
Stick with it. Your goal of five clients is reasonable. Having a specific game plan customized to your desire will help. I am glad to offer you my insights.
Warmly, Brenda
brendabomgardner@aol.ocm
720-260-7702
Hi, Brenda! I’m so glad that you, too, joined this discussion and so appreciate your positivity! 3-5 years is not uncommon at all. I remember being scared for the first 5 years – worrying about paying bills and getting that phone to ring. But, I was fumbling along without a coach / consultant and relying on my friends in mental health to show me the way. It didn’t work so well for me that way and I think that I was not alone.
Many therapists think that because they had good training in school, that they should do just fine in private practice. It doesn’t work that way, does it? In fact, unless you bring a strong business background with you, you need to learn those skills from somewhere – typically post-graduation. Brenda, I appreciate your reference to a marketing / business coach. I don’t want to present a hard sell here for coaching services on my blog but the truth is that my coaching / consulting clients really do learn about shortcuts to building a private practice. The kind of information that a therapist can glean from a few coaching sessions can save years and dollars on building that strong foundation. And, by the way, I love Lynn Grodzki’s books, too!
The other things that you mention, Brenda, that Stephanie and others can take to heart is passion sells everything and customize, customize, customize. That combination of heart and that essence that is uniquely YOU – those are the things that set your practice apart from others and make it appeal to your ideal client. In these difficult economic times, it’s the difference between limping along or thriving – and these are things that every therapist can bring to the table if they just know how!
I have two thoughts about Stephanie’s lack of clientele. The first, based on her email, sounded as if her office is in a city, if so, I would try and get on some EAP (Employee Assistance Program) panels, here in my region, the northern Virginia suburbs of Washington, D.C. there are quite number of EAPs that contract local therapists to provide short-term (usually 3 to 7 session) counseling. You won’t get rich or even sustain a practice on EAP contracts alone but they will bring in clients and as I’m starting to find, if the EAP clients find your work valuable, they tell their friends. Here is a list of EAPs around the US: http://eaplist.com/ Keep in mind some of these EAPs are no longer in business, the list hasn’t been updated in almost 2 years. Also, some EAPs, such as Compsych are national but others are only local or specific to one region. This will take some detective work and a lot of emailing but it sounds like Stephanie is a hard-worker and committed.
My second thought is: lawyers! I have recently reached out to a few local family attorneys, it started out I needed some referrals for a client, now I’m finding that I get occasional referrals from these same attorneys I contacted and spoke with about services. Again, I don’t get a ton of referrals from them but it is the diversity of your referral base that counts (at least that is what I am finding). Based on Stephanie’s niche, I would contact some family attorneys, since they are probably the professionals with clients who have families members with those illnesses and you can discuss cross referral potential.
Aaron! thanks so much for sharing your EAP list with this community! You make some excellent points about EAPs not necessarily able to fill a practice but they can be a good place to showcase your clinical skills. I would encourage all of you who work with EAPs to drop in here to share who it is you are working with and how it’s going for you.
And, Aaron, I love that you mentioned attorneys. They are referral sources that that are often overlooked by mental health professionals which means that if you take the time to cultivate the relationships, you may find that you are the only one your local attorneys refer to!
Thanks for taking time to give such thoughtful suggestions to Stephanie and the rest of us, too!
Stephanie,
I want to add one more thing to my earlier comments. I believe once a niche is identified a person needs to stick with it and polish it. And keep polishing it. I just can’t say enough about branding. The more defined and clear you are about the services you offer to the population you want to work with the easier it is for people to hold onto who you are and the services you offer. Hence, if you are marketing your practice to physicians, lawyers, senior centers, Facebook, tweeting or your peers the branding message needs to be consistent. Even if you are offering free public speaking or free community workshops people will remember you by your tag line or elevator speech during the first three minutes.
You are definitely dedicated and tenacious. I encourage you to keep up the marketing efforts. It took me six months before I got my first full self-pay client. It takes time. The conversation here on Tamara’s blog has a lot of great ideas from many different people. My hope for you is to take the ideas and run with it. Also, be sure to include some self-care along the way.
Warmly, Brenda
Brenda, you’re right on target as usual! Too many therapist treat their practices like hobbies and think branding is for slick Fortune 500 companies in the “business world.” When we fail to realize that our practices are businesses, too, we tend to struggle and then starve. Branding and image management are key to positioning yourself in the marketplace as the go-to professional for mental health. And, being able to speak clearly and succinctly with confidence about the difference you make are skills that take practice and honing. Thanks for the reminders!
Thank you for hosting this engaging conversation. Happy Holidays. Bb
It’s my pleasure! You guys are such a great pool of resources and I so appreciate your willingness to share what you know! Happy holidays to you, too!
Good reading these posts and I would like to add a few tips from the UK.
I too admire the amount of time ‘Stephanie’ is putting into promotional work. I don’t think she sounds “pathetic” but fear that she is beginning to work against herself. Desperation is showing explicitly and this is not an attractive quality for referrers or clients. I suggest :
1) Pulling back for a breather and asking friends or family, even if they are not local, for frank feedback on how she is coming across in literature, website info and personally.
2) Not going out to network, etc. until good feedback is gained and it has filtered through and been reflected on. This will help authenticity in any contact made. I hope it will also reduce the stress of making such contacts as the knowledge gained, even if painful, will give confidence.
3) Shift efforts from modifying website to optimising it.
A note: if already doing Search Engine Optimisation, and then checking by ‘googling’, use another computer as yours will rate recent searches higher and you won’t get a true measure of whether you are hitting the first page in your chosen areas.
I find generally, when we find ourselves overworking with no response, it is not the best thing to just carry on doing more of the same – it becomes a drain. I would encourage a leap of faith to do less and different. Only a little of the right thing can make a big impact. The change is usually an internal one which then reflects in what we put out externally.
My very best wishes for success – Cathy Towers
PS Have we any feedback from ‘Stephanie’ on how she is doing?
Cathy! Welcome to Private Practice from the Inside Out! And, thank you for taking time to make some excellent points! “Pulling back for a breather . . . ,” (and taking time for self-care) is so critical and often not even addressed in our graduate schools. Thank you for making the suggestion.
And, so many of us hang out our shingles and then feel like we are silos of mental health that shouldn’t have to ask for feedback or need anyone else’s advice along the way. Your suggestions about seeking feedback and then actually doing something with it is also a good reminder. Here in the United States, we often hear the saying “Doing the same thing over and over again and expecting different results is the definition of insanity.” And, I might add, it can feel really crazy, too! However, when we find ourselves in the midst of sheer panic, it’s often what we end up doing . . . the same old same old . . . . Yours is a gentle reminder that doing something different can be a way out of the maze.
Your differentiation between changing up a website and optimizing a website is also an excellent point – and that “googling” on your own computer will not give an accurate reflection of your effectiveness at being “found” on the search engines.
“Stephanie” has not reconnected yet. She was concerned about keeping her identity private and so she may be reluctant to update us so soon. However, I have to think that with all of these generous suggestions and good wishes, she’s bound to find at least some of these contributions to be a good fit and helpful to turning her practice around. Will let you know if she does reconnect!
Perhaps she could reach out to others who have small budgets and are working hard to get started? Not to stray from her niche but to draw from the ebbs around it. Look up massage therapists who might have clients who are care-takers, yoga instructors, and other care-side providers who are local and small. A co-op can be as simple as meeting for coffee in the park to discuss who has gone where and what leads each other may have found. Sometimes these small struggling groups can be more beneficial when one is lacking the funds and energy to devote to luncheons and membership fees. I’m not suggesting something that requires contracts and LLCs but just sharing information and support.
Also, “Aging and dementia” immediately suggests to me: medical supply companies, pharmacies, medical transport companies, respite workers, social services, and so on. Stephanie could draw a circle on a sheet of paper (in the center) and then draw 40 bubbles around the center circle. In the center put her name, business, and/or niche then work even if only 5 minutes at a time to fill in those 40 circles with the names or types of businesses which are “fed” by that niche. Once that is done, compare that with the “getting out there” list she has and see how they are different. Focus energy in those areas which have not been contacted.
The other thought I had was that people who need the services she hopes to provide tend to be energy and resource intensive for the care-givers. Unlike people who voluntarily “sign-up” for those jobs, full-time in home care providers such as adult children may be ill-equipped to manage the reality of the task. So perhaps she could “host” a support-group or psycho educational class/seminar which offers people information on the issue and resources to manage the issue. Newspapers and other media floods are usually free if the event will be free and often a room can be secured at a hospital, school, or elder-care facility free of charge as well. Stephanie could invite someone to speak from the counsel for the elderly, the clergy, or something similar.
Think like a non-profit! Not everything open to a 501c3 will be open to a for profit company but many will. Sometimes it just takes standing in a new spot to open a new way of thinking. There are usually more than two options, but we often times can’t see other ways especially when we are stressed and tired ourselves.
Karen! Thank you so much for adding such great ideas to this conversation! You and the others who have taken time here to speak up are the very reason the Private Practice from the Inside Out community is so special. You are obviously an out-of-the-box thinker.
Your suggestions are excellent additions to our growing bank of ideas. And, your last paragraph really resonates with me – there is always more than one “right” way. I was listening to National Public Radio this morning where Eric Weiner was being interviewed about his new book, Man Seeks God. He said he spent time with the Sufi Whirling Dervishes learning about their practices. Apparently the spinning that they do is a form of prayer and is intended to remind them that they already have what they need if only they will turn toward it. I think that’s true for those of us building private practices. Often times we simply turn our backs to the solutions. You offer some excellent suggestions for anyone interested in growing their business – and sometimes it’s as simple as standing in a new place.